Provider Demographics
NPI:1699901025
Name:CHAVEZ, JACOB XAVIER (PLMHP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:XAVIER
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 O RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NE
Mailing Address - Zip Code:68959-6723
Mailing Address - Country:US
Mailing Address - Phone:308-293-7720
Mailing Address - Fax:
Practice Address - Street 1:2041 E 56TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4179
Practice Address - Country:US
Practice Address - Phone:308-236-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health